Thursday, April 30, 2009

Health Agenda Hijacked by Fashion, Again

The latest health scare is swine flu and people in East African countries are right to be scared. Swine flu may not reach their countries, it may not even be a very deadly form of flu, but the ability of countries to prevent epidemics is virtually non existent in this region. In the past few months, Kenya has had outbreaks of cholera in many parts of the country; not long ago it was Rift Valley Fever that was going around. Even bird flu alerts are still in place in many areas.

Somalia has yet to respond to the threat of swine flu, as has Burundi. Other East African countries have issued directives or have plans to do so. Hopefully the flu will never get here. If it does get here, hopefully those measures will prevent it from spreading. The only practical suggestion available for members of the public so far is to wash their hands regularly. Many people may do that already, but in most places, they will wash their hands with contaminated water.

If East African has the luck or the resilience to avoid a swine flu epidemic, they probably won’t have to wait too long for the next serious threat. Besides, they don’t need to wait for threats. Their depleted health services are currently struggling to deal with a multitude of epidemic and endemic conditions. At present, the number of doctors available per 100,000 people in Kenya is 14 (compared to 250 in the UK). In Uganda the number of doctors is 8, in Tanzania, only 2. This is unsurprising, given that public expenditure on health in Kenya is a measly 1.8% of GDP; in Tanzania the figure is 1.7%, in Uganda, 2.5% (similar to each country’s military expenditure).

In East African countries, some of the biggest killer diseases are acute respiratory infections, diarrhoea, malaria, TB and Aids. Aside from Aids, all these diseases can be prevented and cured. But not enough money is spent on public health, especially reproductive and sexual health, childhood immunisation, water and sanitation, food security and nutrition, habitation and labour conditions.

If public health has been allowed to slip so far down the agenda, emergency measures to prevent swine flu will require more luck than skill. So rather than obsessing about each and every health threat as and when it arises, East African countries would be better to look at long term declines in health, education, infrastructure, social services and governance. When a country is taken by surprise, it is their existing capacity and resilience that determines how they fare.

Ironically, one thing that may reduce the threat from swine flu in East Africa is the lack of tourists and visitors they are currently receiving. Several of the countries are at war, are experiencing some kind of civil disturbance or have recently had a civil disturbance. Even Tanzania, which is very peaceful, is not seeing many tourists, partly because it’s the rainy season, partly because the global financial instability has reduced the numbers of people going on exotic holidays.

When it comes to spreading infectious diseases inside a country or region, it is often the most mobile who play the biggest part. Migrants can take diseases to their destination country, spreading them among their fellow migrants; they often have to live in close proximity to other migrants, in cramped and dangerous conditions. They also return home with transmissible diseases, such as sexually transmitted infections, HIV, meningitis and TB. So they can be responsible for spreading diseases among whole populations, both directly and indirectly.

Another irony, then, is the fact that some of the industries most associated with internal migration, mining, horticulture and raw materials production, for example, are also currently depressed. (These are also some of the industries most associated with the spread of infectious diseases and other health hazards.) Many projects are on hold and people are being laid off in huge numbers. The cut flower growing industry in Kenya and gold and precious stone mining in Tanzania are examples. Therefore, circular migration, inside countries and inside the region, is probably relatively low and declining at present.

The point is not that East African countries are in big trouble if swine flu arrives. The point is that East African countries are already in trouble and have been for a long time. If the next hazard is not swine flu it will be something else. Millions of people in East Africa (and other developing countries) are dying every day from preventable and curable diseases because of lack of access to basic things like clean water and nutritious food. East African countries need to build up their health, education and all other social services. Don’t let the threat of swine flu distract attention from everything else. Does that sound familiar?


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